BACKGROUND: India is the second-largest consumer and third-largest producer of tobacco globally, with tobacco use being a major cause of morbidity and mortality. This study examines inter- and intra-social disparities in tobacco consumption and identifies key factors contributing to smoking and smokeless tobacco (SLT) use among tribal populations.
METHODS: Cross-sectional data from 74037 adults (≥15 years) were analyzed using the Global Adult Tobacco Survey (GATS) India (2016–17). Descriptive statistics with the Chi-Square test, multivariable logistic regression, and a non-linear multivariable logit Oaxaca decomposition model were employed to measure social disparities in smoked and SLT use. The analysis explored associations between tobacco use and socio-demographic characteristics across various social groups.
RESULTS: Tobacco use was significantly higher among tribal men, with 14.4% consuming smoked tobacco and 33.7% using SLT, compared to Scheduled Caste (SC) men (14.3%, 26.4%) and men from other castes (12.2%, 21.4%). Gender differences were stark: 12.8% and 23.4% of men used smoked and SLT, respectively, compared to 1.5% and 12.3% of women. Men were 16 times more likely to smoke [AOR: 16.449; 95% CI: 14.56–18.59] and 1.4 times more likely to use SLT [AOR: 1.417; 95% CI: 1.34–1.50] than women. Smoking prevalence was 64% higher and SLT use 29% higher among tribal men compared to men from other castes. Men from other castes were 19 times more likely to smoke than their female counterparts, while tribal men were 12 times more likely.
CONCLUSIONS: Tobacco use is disproportionately high among tribal older males, individuals with low education levels, the poorest households, those experiencing disrupted marriages, and rural residents in Central, Eastern, and Northeastern regions of India. Targeted preventive interventions, awareness campaigns, and policy measures should prioritize tribal populations to align with Sustainable Development Goal 3.a.